This collection contains theses and dissertations submitted by graduate students under the Department of Biobehavioral Nursing for either a Master of Science degree or a Doctor of Philosophy degree.

Recent Submissions

  • Partnering With a Formal Program: Expanding the Boundaries of Family Caregiving for Frail Older Adults

    Poole, Deborah K.; Department of Biobehavioral Nursing (1999-12)
    Caring for frail older adults at home is an increasingly common lifestyle among American families. A growing array of community-based programs has been developed to assist family caregivers in this endeavor. Certain of these programs are comprehensive in nature and require a particularly close working relationship between the program’s health professionals and the lay caregiver at home. A paucity of literature exists that can act as a guide to formal and informal caregivers within such a context as they strive to develop an effective working relationship. This study used grounded theory methodology to develop a substantive theory of the process by which family caregivers of frail older adults establish and maintain a working relationship with a comprehensive formal caregiving system. The context of the study was a program belonging to the Program of All-inclusive Care for the Elderly (PACE) network. An initial sample of six primary caregivers of PACE participants was selected. The primary means of data collection was in-depth individual interviews with documents review also being used as a data source. An additional 13 primary caregivers were chosen via theoretical sampling for a total sample size of 19 informants. The method of constant analysis was employed to direct data acquisition and analysis until saturation was complete and the core variable was identified. The basic social-psychological problem identified by informants was termed Helplessness, defines by them as “needing additional help with caregiving.” Partnering with the Program was the basic social-psychological process informants used to relieve their helplessness in caregiving. Partnering with the Program was comprised of three phases: Connecting, Discovering Self, and Transcending Self. The first phase of Connecting represented “the honeymoon phase” of the relationship with the program and was made up of three stages: finding out, “joining up”, and adjusting. Discovering Self, the second phase, had three stages: communicating concerns, evaluating the program’s response, and expecting more. Informants in this phase related with the program in a conflicted manner, wanting to assert their autonomy but realizing their dependence on the program. The final phase, Transcending Self, was also made up of three stages. These stages were monitoring, advocating, and choosing to work it out. The hallmark of the final phase was that informants chose to have a positive, family-like personal relationship with the program staff rather than perpetuate conflict over unmet desires about service provision. This substantive theory provided information heretofore unavailable regarding the trajectory of close healthcare relationships from the perspective of the family caregiver. Implications of the theory related to health and social policy, clinical practice with older adults, and nursing knowledge are made explicit in the final chapter of the report.
  • A Grounded Theory Study o f Pain Management Behaviors in Nurses Caring for Preverbal Children

    Noviello, Sheri R.; Department of Biobehavioral Nursing (2006-05)
    A qualitative study using the grounded theory method was used to explore factors that affect nurses’ pain management decision-making when caring for children between the ages o f 0 and 3 years. This study was approved by the Human Assurance Committee at Medical College o f Georgia prior to the collection of data. The sample consisted of eleven nurses who were employed at three different hospitals in the southeastern part of the United States. Theoretical sampling was the basis for the selection o f participants after the first two interviews. Interviews were transcribed verbatim and were subjected to open and axial coding. The constant comparative method was used during data analysis to identify a core category and related concepts. The basic social process that emerged is engaging in tactics o f pain management. This process contained two other processes: assessing fo r pain and managing a pain episode. Intrinsic factors that affected assessing fo r pain included knowing the territory, personal attributes o f the registered nurse (RN), being a parent, and being connected. Extrinsic factors that affected engaging in tactics o f pain management included workload and culture o f the hospital. The process of managing a pain episode included five phases: eliminating other sources o f discomfort, judging pain, comforting, medicating, and letting go.
  • An Interdisciplinary Team Approach to Decision-making About the Use of Psychotropic Medication for Individuals with Mental Retardation

    Natvig, Deborah A.; Department of Biobehavioral Nursing (1993-05)
    The purpose of this study was to examine a decision-making model for developing psychotropic medication plans for individuals w ith mental retardation. The study examined relationships among medication knowledge, acceptance of the interdisciplinary team (IDT) process, leadership, consensus, and the quality of the psychotropic medication plan. The study w as conceptualized using Henderson's Model for Nursing. Henderson (19 6 6 ) identified the nurse as an active participant on the IDT who helps plan and implement care designed to m eet the needs of the individual. T w o hundred eight (N = 208) team members from 4 9 interdisciplinary psychotropic medication review teams participated in th e study. Team s from all four large regional Intermediate Care Facilities for the M entally Retarded (ICFs/MR) in one southeastern state participated. Multiple regression and hierarchical multiple regression analyses were performed to test the hypotheses. The first hypothesis, that consensus would be predicted by medication knowledge, acceptance of the IDT process, and leadership w as partially supported. Leadership w as a significant predictor of consensus. The second hypothesis, that the quality of the psychotropic medication plan would be predicted by medication knowledge, acceptance of the IDT process, and leadership was not supported. The third hypothesis, which added consensus to the model, did not explain any additional variance in the quality of the psychotropic medication plan. As part of this study, The Psychotropic Review for Interdisciplinary Decisions and Evaluation (PRIDE) scale w as developed to assess the quality of psychotropic medication plans. Several threats to statistical conclusion validity were identified, which may have Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. affected the results of the study. These included: small sample size, lack of independence of teams, low variability of responses to instruments, and multicollinearity. Psychotropic medication plans from some ICFs/MR were superior to those produced by others. Characteristics of the ICFs/MR, such as, the amount of guidance given to teams through written guidelines and policy, and the degree of administrative support reflected through availability of staff to participate in the review process, may have been the most significant factors influencing the quality of psychotropic medication plan produced.
  • Race and Income Association with Health Service Utilization for Veterans with Heart Failure

    Landrum, Laurie G.; Department of Nursing (2012-07)
    Disproportionate heart failure outcomes exist for Blacks in the Veterans Health Administration (VHA) despite equitable access and financial barrier minmization. No study has examined the association of race and income with health service utilization for veterans with heart failure. This observational study investigated race and income associations with readmissions, bed days of care, and emergency room (ER) visits for veterans with heart failure after controlling for predisposing, enabling, and illness severity factors. Medical record data were collected for 149 veterans telemonitored for heart failure during 2008-2011. Heart failure symptoms severity and comorbidities were measured using investigator-adapted scales based on the New York Heart Association IIV scale and the Charlson comorbidity index. Heart failure related outcomes (30 day, 90 day, 1 year, and total readmissions, ER visits, and total bed days of care) were modeled controlling for age, marital status, and heart failure and comorbidity severity. Of patients younger than 60 years of age, 18% were Black compared to 11% of Whites, Χ2 (2, N=149) = 5.15, p= .02. Blacks had a much higher comorbidity prevalence than Whites, p = .000. Ischemic heart disease and chronic kidney disease rates were double and triple national VHA rates, respectively, among Whites and Blacks. Race did not predict readmissions, bed days of care, or ER visits. The odds of a readmission or bed day of care ever decreased by 38% and 43%, respectively, for married men, p = .03. The odds of a readmission or bed day of care ever due to severe heart failure—compared to less severe heart failure—were four to five times higher, respectively, p ≤ .004. Income increased the odds of total bed days of care by 14%, p = .00, holding race constant. Overall, the sample experienced far fewer readmissions, bed days of care, or ER visits, compared to VHA national rates, but sample size may have limited accurate comparisons.
  • An Analysis of Diabetes Predictors and Diagnostic Tests in a Sample of African Americans at Risk for Diabetes

    Williams, Lovoria B.; Department of Biobehavioral Nursing (2011-05)
    Recently the ADA and International Expert Committee (IEC) endorsed HbA1C for diagnosis of glucose states. Concerns exists regarding discordance between fasting plasma glucose (FPG) and HbA1C; the committees do not agree on the HbA1C cut-point for diagnosis of sub-diabetic states; and the HbA1C may be more sensitive in AAs. A secondary data analysis of the Fit Body and Soul (FBAS) sample (n = 393) was conducted. FPG and HbA1C values were classified by the current ADA and the IEC HbA1C criteria. A risk factor analysis was also conducted. Results indicate different subject classification based on choice of diagnostic test and criterion used. Subjects classified as normoglycemic based on ADA FPG, ADA HbA1C and IEC HbA1C criterion were (78.9%; 30.7%; 55%) of the sample, respectively. Sub-diabetic state was (18.1%; 55.9%; 31.5%), respectively. Diabetes was (3%; 13.4%; 13.4%), respectively. Moderate correlation exists between HbA1C and FPG (Pearson’s r = 0.63 p < 0.001); there is only slight to fair agreement between ADA HbA1C and ADA FPG classifications and IEC HbA1C and ADA FPG classifications; Cohen’s Kappa = 0.127; 0.234 (p < 0.001), respectively; McNemar’s Chi Square (χ23df = 182.8; 81.54 p < 0.001) respectively. Significant predictors of HbA1C by linear regression were waist circumference (WC) and age; FPG predictors were age, WC and family history of diabetes. The risk factor analysis indicated poor agreement with either diagnostic test.
  • A Mindfulness Model of Emotion Regulation in Nursing Students: Working Memory Capacity as a Regulatory Mechanism

    Dubert, Christy J.; Department of Nursing (2013-04)
    Nursing students often struggle with transitioning from education into clinical practice. These students may be overwhelmed with the emotional demands and high cognitive load resulting from the unpredictable post-graduation/professional work environment. A lack of research exists investigating how nursing students regulate their emotions and what cognitive emotional regulation strategies they use when dealing with the cognitive and emotional demands of nursing school. The integration of mindfulness training into nursing curricula has the potential to facilitate the development of nursing students’ working memory capacity (WMC) and improve emotion regulation (ER) skills. Although a few studies have investigated mindfulness training with nursing students, there is a lack of empirical evidence examining how dispositional mindfulness and WMC influence a nursing student’s ability to regulate their emotions. Research evidence suggests that dispositional mindfulness is linked to ER. However, whether: (a) ER is influenced by dispositional mindfulness; (b) WMC mediates this relationship; and (c) if these factors are different between education levels has not yet been determined in nursing students. This cross-sectional study examined the relationships between mindfulness, WMC, and ER in a pre-licensure nursing student population from a southeastern Georgia university. Two questionnaires and a WMC task were completed by the sample (n = 80). A path model of the relationships between mindfulness, WMC and ER was tested using structural equation modeling. Factor differences between the four education levels were tested using one-way ANOVA. Mindfulness was positively associated with ER (r = 0.1905, p = 0.045) and WMC (r = 0.2977; p = 0.004). The path analyses revealed that there was a direct effect of mindfulness on ER (γ11 = 0.292, p = 0.034) and WMC (γ21 = 4.975, p = 0.004). However, the indirect effect of mindfulness on ER was not statistically significantly mediated by WMC (β = - 0.03, p = 0.236). Furthermore, mindfulness was significantly different between the first semester students having the highest level of mindfulness and the fourth semester students having the lowest level of mindfulness, F(3, 76) = 4.12, p < 0.05. Dispositional mindfulness may influence ER and WMC in nursing students, but the downward trend of mindfulness from first to last semester is concerning. Nurse educators may consider using mindfulness training to enhance mindfulness, WMC and ER.